Doctor is Me
Author: Torie Johnson, MD MPH
Keywords: gender discrimination, professional identity formation, equity and inclusion, culture of medicine
A scene in the movie “Barbie” is all too familiar to female physicians. Ken asks a female physician, “Can I talk to a doctor?” and she replies, “You are talking to a doctor.” He ignores her, then requests her assistance with various menial tasks (“can you get me a coffee…and I need a click-y pen”) before abruptly walking off in the direction of two short-haired, presumably male medical professionals, saying, “There he is! Doctor!”
Like many scenes in “Barbie,” the doctor scene made me feel like laughing and crying at the same time. The disenfranchisement of the female doctor in “Barbie'' contrasts sharply against the female-led alternate reality of the movie’s “Barbie Land,” a matriarchal society where the entire Supreme Court and the President are all female. This scene brings into–more comfortable, comedically distanced–focus the sexism that continues to pervade medical training and practice. In our non-cinematic “Real World,” even after women physicians tell patients we are doctors, patients often still do not comprehend we are, so internalized are gender-based stereotypes.
One of the funniest times (of many) this happened to me, was when a man wearing a tie and a stethoscope around his neck (assumedly another doctor) entered the hospital room where I was seeing a patient and asked, “Are you the nurse?” I shook my head no and then he continued, “PT? Pharmacist? OT? Dietitian?” and I continued shaking my head until I realized he was heading down a path of asking about every non-physician role in the hospital, when I finally stopped him: “Physician–I’m a physician.” It’s hard not to laugh at this real-life scene, but it’s also hard not to feel like crying as we recognize in it our sexist reality.
But what does being a doctor mean exactly? As a woman in medicine, I find myself identifying more with Ken in the movie when he sings, “doesn’t seem to matter what I do, I’m always number two.” Yet, as more and more studies point to better care quality by female physicians, I also can’t help but think that maybe, like Ken, “anywhere else I’d be a 10.”
“Barbie” has made me question how much I have always been auditioning for the role of “Doctor,” a socially-constructed archetype motivated by heteronormative masculine values and reinforced by a male-dominated hierarchical structure. This stereotyped “Doctor” is generally performed by hetero-cis white men in movies as well as in medicine’s cultural mythology. He is physically infallible, emotionally impenetrable and all-knowing, walking a fine line somewhere in between super-human and inhuman.
Unable to acknowledge his limitations, this “Doctor” lacks the courage to admit he doesn’t know, compromising the truth to preserve his delusion of omniscience. He refutes the notion that the safety and quality of his care might be susceptible to the deleterious effects of exhaustion. He places excess value on being tough, never backing down from a challenge, even if it means taking unnecessary risks related to patient care, and he mistakes this for resilience. He views emotional vulnerability as weakness, and thus sacrifices opportunities for meaningful connections with patients, families and colleagues. He lives in a constant state of denial, and his deficiency of self-awareness contributes to mental health and addiction issues. He is wholly inauthentic not only to others, but to himself.
I have spent much of my professional life being defined by and measured against this “Doctor” and trying to squeeze myself into this role. The funny thing is that I, and probably most physicians, regardless of gender identity, don’t even really want to be this “Doctor,” but our collective fear is that if we don’t at least outwardly align with him, we will be delegitimized.
This toxically masculine archetype is as outdated as bloodletting and has a similarly unfavorable risk/benefit ratio for continuing as a mythical guidepost for physicians’ professional development. It greatly limits us all at best, and at worst, does real damage to our own health and the health of our patients and communities. It is harmful for all physicians who don’t fit this mold, not just women and physicians from marginalized communities, but actually–to varying degrees–all of us.
In 1984, Perri Klass described the “macho” culture of medicine: “The essence of macho…is that life is a perpetual contest. You must not let others intrude on your stamping ground.” Female physicians have long been intruders on medicine’s stamping ground, a field “designed for and by men,” and toxic masculinity in medicine creates fertile soil for the continued disenfranchisement of non-hetero/cis, non-white and non-male physicians. Organizing around and yielding to the interests of powerful men, macho “Doctors” consolidate power by quietly disempowering others. And by seeking validity from within a toxically masculine culture, non-hetero/cis, non-white and non-male physicians unintentionally undermine themselves.
Dr. Klass was hopeful that an increase in female physicians might help to change the macho culture of medicine. Almost 40 years later, even with a much higher proportion of female physicians, this problem persists. A likely contributing factor is that there are still too few female physicians in the leadership spaces where the toxically masculine “Doctor” myth has the best chance to be disrupted. But also, this myth is so deeply embedded in the culture of medicine, that most physicians, including women, perpetuate it, even to our own detriment.
Ken has a breakthrough moment in “Barbie” where he realizes that he is not just defined in Barbie’s shadow, that he is not “just Ken,” but rather that “Ken is me.” Similarly, maybe it’s not enough for female physicians to repeatedly insist, “I AM a doctor!” or “#Ilooklikeadoctor” or “#Ilooklikeasurgeon,” but rather, it’s “a doctor is me.”
Maybe we can all stop trying to be macho “Doctors”; maybe we can just be the one we are, the one who is humanly imperfect and also “Kenough.” And I think, as a profession, if we can push back against this harmful myth, we will all be a little bit—as the Indigo Girls sing in “Barbie”—“closer to fine.”
About the Author: Torie Johnson, MD, MPH, is an academic internal medicine physician at University of Illinois Chicago.
